AB0727 Study of the indicators dynamics of the pulmonary functional tests (PFTs) and X-ray picture against during the 36-month immunosuppressive therapy (IST) of interstitial lung disease (ILD) in patients with systemic sclerosis (SSc)
Authors: O. Koneva, L. Garzanova, O. Ovsyannikova, N. Kovaleva, L. P. Ananyeva, O. Desinova, M. Starovoytova, R. Shayakhmetova
Journal: Annals of the Rheumatic Diseases (2022)

Background HRCT is the gold standard for confirming ILD.However,the role of HRCT for estimating the effectiveness of therapy is not determined in full. Objectives To assess the dynamics of X-ray changes and PFTs during IST in pts with SSc and different prevalence of ILD according to HRCT. Methods The study included 37 pts with signs of ILD(the average age-53.1±11.5 yrs,the ratio of m/w- ¼, d/l–1/1.8,the SSc-duration-10.9±9 yrs).For all pts at the time of inclusion in the study and after an average of 34±2.3 months were studied FVC,DLC and HRCT.The pts received IST during the follow-up period.The ILD dynamics was assessed as follows:improvement,deterioration and no dynamics.The analysis of HRCT data was conducted at 5 levels.The severity of changes by type of ground-glass,reticular changes,traction bronchiectasis,and honeycombs were evaluated(0–3 points).The dynamics of X-ray changes and PFTs was separately assessed in pts with the prevalence of interstitial changes up to 20%(group A,n=23) and more than 20%(group B,n=14) of the total area of lung tissue. Results In the general group during the IST CT-improvement was noticed in 13(34.2%),deterioration–in 9(24.3%) pts.There was no dynamics in 15(40.5%)pts. Parameters All group (n=37) р Group А (n=23) р Group В (n=14) р РBetween groups А and В point “1” point “2” point “1” point “2” point “1” point “2” Negative CT-dynamics, n/% 9/24.3 4/17.4 5/35.7 0.008 Positive CT-dynamics, n/% 13/34.2 6/42.9 7/30.4 0.06 Mean CT-score, points (M±σ) 9.6±8.2 9.4±8.3 0.7 4.1±3.9 0.5 18.07±5.6 18.1±6.1 1 р1=0.000038 р2=0.000001 “Ground-glass” score, points (M±σ) 5.1±3.3 4.95±3.3 0.6 1.9±2.6 (median-0 [0;3]) 1.3±2.1(median-0 [0;2]) 0.12 5.4±2.6 4.6±3.2 0.3 р1=0.018 р2=0.013 Reticular changes score, points (M±σ) 7.4±3.7 7±3.4 0.4 2.6±2.4 2.7±2.3 0.7 7.9±2.4 7.6±1.98 0.3 р1=0.0007 р2=0.0004 Traction bronchiectasis index, points (M±σ) 1.67±2.3 (median-0 [0;3]) 2.0±2.6(median-1 [0;3]) 0.02 0.5±1.2 (median-0 [0;0]) 0.7±1.3(median-0 [0;1]) 0.1 7.8±2.0 7.6±2.0 0.7 р1=0.000000 р2=0.000000 FVC, % of proper values (M±σ) 94.2±19.5 94.6±16 1 92±18.9 91.9±19.6 0.95 89.2±21.5 90.3±14.2 0.23 р1=0.7 р2=0.8 DCL, % of proper values (M±σ) 57.3±20.2 57.9±20.7 0.6 60.6±19.6 62.6±19.1 0.3 47.6±11.4 45.2±13.5 0.22 р1=0.13 р2=0.02 * Between groups А and В . Point “1”–at the time of inclusion in the study; point “2”–at the time of the last examination. On average,values of FVC and DLC remained stable.None of the pts with improvement of HRCT showed a deterioration of FVC.Among pts with the X-ray picture deterioration,in 2 cases,there was a decrease in FVC by 5% or more;in other cases,indicator stabilized.The mean CT score did not change during the therapy.In group B,the total CT score and the average score of ground-glass,reticular changes,and traction bronchiectasis were significantly higher.Changes by type of “honeycombs” were mainly revealed in group B.During the IST,positive X-ray was detected in 6(42.9%) pts of group A, in 7(30.4%) pts of group B(p=0.06),and negative X-ray dynamics–in 4(17.4%) pts of group A, in 5(35.7%) pts of group B(p&gt;0.05).During the IST,the mean values of DLC and FVC did not significantly change in both groups. Conclusion Semi-quantitative evaluation according to HRCT in pts with SSc-ILD did not reveal any dynamics in the total score of structural changes during IST,which coincided with stable indices of PFTs.Pts with less common pulmonary involvement during therapy were more likely to demonstrate positive CT-dynamics. With an increase in the prevalence of ILD,signs of fibrosis increased.Most pts had unidirectional dynamics of values of FVC and CT-changes,which confirmed the possibility of effective use of HRCT to assess the conducted therapy. Disclosure of Interests None declared